Science Alert: Intermittent catheterization for Bladder management – can infections be avoided?

Posted by Maria Åberg Håkansson, January 30, 2018

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Intermittent catheterization is today a first choice therapy for people with neurogenic or non-neurogenic lower urinary tract dysfunction related to incomplete bladder emptying. In recent years, the evidence for the safety of catheter reuse has been debated. 

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At the core of the debate has been the ability (or non-ability) of catheters or catheter techniques to affect the main complication of catheterization, i.e. urinary tract infection (UTI). In 2014, a Cochrane review on this topic was released, concluding that there was a lack of evidence in favor of any specific catheter and/or technique. This conclusion was questioned by a recent publication, in which some of the analyses were redone using an updated methodology. Contrary to the 2014 Cochrane review, the 2017 revision concluded that the use of hydrophilic catheters reduces the risk of urinary tract infection and that there is a trend favoring single-use catheters. Furthermore, the latter was verified by another recent publication which looked at convenience of single-use vs. multiple-use catheters from the patient perspective. The study showed that single-use (as opposed to multiple-use) intermittent catheters can facilitate handling and increase quality of life for people with neurogenic bladder. Increased quality of life is a central factor for adherence to and long-term success of the therapy.

The fact that single-use hydrophilic-coated catheters are the only ones (so far) proven to reduce the risk of UTI associated with intermittent catheterization, suggests that they can be part of many solutions. For example, a new study shows that there is a great need for bladder management solutions for children with neurogenic bladder; such solutions are necessary for about 93% of children with spina bifida. Another study points out the increasing rates of antimicrobial-resistant bacteria in children using intermittent catheterization. As we know that increases in resistant bacteria are linked to the use of antibiotics, measures to prevent infection in this population are key in slowing the trend. Antibiotic-coated catheters do not seem to be an effective solution and evidence suggests that hydrophilic-coated catheters instead have a greater role to play in avoiding infections.

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Summary of Publications


Intermittent catheterization: The devil is in the details.

https://www.ncbi.nlm.nih.gov/pubmed/29108476


Author and Origin
Christison K, Walter M, Wyndaele JJM, Kennelly M, Kessler TM, Noonan VK, Fallah N, Krassioukov AV.
Canada

Summary

Meta-analysis and review of previously published Cochrane review by Prieto et al. 2014; ‘Intermittent Catheterisation for Long-Term Bladder Management’.

Conclusions

Conclusions of the previously published Cochrane review are questioned and new ones are proposed, i.e.: use of hydrophilic catheters reduces the risk of urinary tract infection; and there is a trend toward favoring single-use catheters.

Comments

Study describing the critique and new analyses behind the withdrawal of the 2014 Cochrane review by Prieto et al., evaluating catheter types and techniques for intermittent long term use.


Effects on Quality of Life in Patients with Neurogenic Bladder treated with Clean Intermittent
Catheterization: Change from Multiple Use Catheter to Single Use Catheter.

https://doi.org/10.3339/jkspn.2017.21.2.142

Author and Origin
Park CH, Jang G, Seon DY, Sun IY,
Ahn CH, Ryu H-y, Lee SH, Kim KM.
Korea

Summary

Observational survey of 38 patients with neurogenic bladder who practiced intermittent catheterization
and changed from a multiple-use to a single-use catheter.

Conclusions

Higher scores of ease of use, convenience, and health-related quality of life were reported for single-use catheters compared to multiple-use catheters, using a modified version of the Intermittent Self-Catheterization Questionnaire
(ISC-Q).

Comments

Study showing that single-use (as opposed to multiple-use) intermittent catheters can facilitate handling and increase quality of life for people with neurogenic bladder.


Longitudinal Study of Bladder Continence in Patients with Spina Bifida in the National Spina Bifida Patient Registry.

https://doi.org/10.1016/j.juro.2017.11.048

Author and Origin 
Liu T, Ouyang L, Thibadeau J,
Wiener JS, Routh JC, Castillo H,
Castillo J, Freeman KA, Sawin KJ,
Smith K, Van Speybroeck A, Valdeza R.
US

Summary

Observational retrospective study of data collected in the US National Spina Bifida Patient Registry between 2009 and 2015, involving 5,250 patients. Factors associated with bladder continence were
explored.

Conclusions

In the studied sample, mean age was 16 years, 22% had undergone continence surgery, 93% used
bladder management, and 46% reported bladder continence. Continence was associated with demographics, social and clinical factors, surgery and bladder management.

Comments

Study providing epidemiological data on continence in children with spina bifida.


Frequency of Multidrug-Resistant Organisms Cultured From Urine of Children Undergoing Clean Intermittent Catheterization.

https://www.ncbi.nlm.nih.gov/pubmed/29186590

Author and Origin 
Forster CS, Courter J, Jackson EC,
Mortensen JE, Haslam DB.
US

Summary

Observational retrospective study studying antimicrobial resistance patterns in 14,832 urine cultures from children undergoing intermittent catheterization.

Conclusions

Antimicrobial resistance rates are increasing and the increase is higher for patients who require intermittent catheterization than in those who do not. Careful monitoring is recommended.

Comments

Study showing increasing rates of antimicrobial resistant bacteria in children using intermittent catheterization.


Efficacy of Antibiotic Coated Clean Intermittent Catheterization in Children with Neurogenic Bladder.

http://asrjetsjournal.org/index.php/American_Scientific_Journal/article/view/3602

Author and Origin 
Akincia A., Tellib O, Hajiyevc P,
Cansu Bozacıd A, Mamadove E,
Altanf M, Serkan Doğang H,
Soygürh T, Burgui B, Tekgülj S.
Turkey

Summary

Observational retrospective study comparing intermittent catheters with or without antibiotic coating
(chitosan) in 126 children with neurogenic bladder.

Conclusions

There was no significant difference in asymptomatic bacteriuria or urinary tract infection.

Comments

Study investigating use of an antibiotic-coated catheter by children with neurogenic bladder who practice intermittent catheterization.


This blog post is an extract of the Science Alert from Dec 2017 (76040-USX-1712)

Topics: Clean Intermittent Catheterization (CIC), Neurogenic bladder, Lower Urinary Tract Symptoms (LUTS)